Postural control deficits in people with fibromyalgia: A pilot study
– Source: Arthritis Research & Therapy, Aug 2, 2011
By Kim D Jones, Robert M Bennett, et al.
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Introduction: Postural instability and falls are increasingly recognized problems in fibromyalgia (FM). The purpose of this study was to determine if FM patients, compared to age-matched controls, had differences in dynamic posturography, including sensory, motor, and limits of stability.
We further sought to determine if postural instability was associated with strength, proprioception and lower extremity myofascial trigger points (MTPs), FM symptoms and physical function, dyscognition, balance confidence and medication usage. [Note: Propioception is an ‘automatic’ awareness of our body’s position and motion in space.]
Lastly, we evaluated self-report of falls over the past six months.
Methods: This cross sectional study compared middle-aged FM patients and matched, healthy controls (HCs) who underwent computerized dynamic posturography [postural control] testing, completed the Revised Fibromyalgia Impact Questionnaire (FIQR) and balance/fall questionnaires.
All subjects underwent a neurological and musculoskeletal exam. Descriptive statistics were used to characterize the sample and explore the relationships between variables. The relationships between subjective, clinical and objective variables were evaluated by correlation and regression analyses.
Results: Twenty-five FM patients and 27 HCs (combined mean age 48.6 +/- 9.7 years) completed testing.
• FM patients scored statistically lower on composite sensory organization tests (primary outcome, P<0.010), as well as vestibular [inner ear], visual, and somatosensory [sense processing] ratio scores on dynamic posturography.
• Balance confidence was significantly different between groups, with FM patients reporting less confidence than HCs (81.24 +/- 19.52 v 98.52 +/- 2.45, P<0.001).
• Interestingly, 76% to 84% of FM patients had gastrocnemius and/or anterior tibialis myofascial trigger points. [The gastrocnemius is the muscle that makes up the ‘bulge’ of the calf. The anterior tibialis is the muscle extending down the shin.]
Postural stability was best predicted by dyscognition, FIQ-R and body mass index.
• 3 of 27 (11%) healthy controls had fallen only once during the past 6 months
• Whereas 18 of 25 (72%) FMs had fallen at least once.
• 15 (60%) of FM patients reported falling more than 3 times in the past 6 months.
This study reports that middle-aged FM patients have: consistent objective sensory deficits on dynamic posturography, despite having a normal clinical neurological exam.
Further study is needed to determine prospective fall rates and the significance of lower extremity myofascial trigger points.
The development of interventions to improve balance and reduce falls in FM patients may need to combine balance training with exercise and cognitive training.
Source: Arthritis Research & Therapy, Aug 2, 2011. DOI:10.1186/ar3432, by Jones KD, King LA, Mist SD, Bennett RM, Horak FB. Fibromyalgia Research Unit, Schools of Nursing & Medicine, and PT Balance Disorders Laboratory, Neurological Sciences Institute, Oregon Health & Science University, Portland, Oregon, USA. [Email email@example.com]